Anthony Santamaria of of North Hollywood was sentenced to 120 months’ imprisonment for his participation in an approximately $2 billion international health care fraud conspiracy. Santamaria is the third member of a Moscow-based criminal organization sentenced this month in connection with the scheme.
Co-defendants Hershel Tsikman of Studio City and Hafizullah Ebady of Parsippany, New Jersey were sentenced earlier this month to 120 months’ and 97 months’ imprisonment, respectively. In addition to the terms of imprisonment, the federal judge ordered Santamaria to forfeit $3.2 million and Ebady to forfeit more than $1.8 million. Additionally, all three defendants were ordered to pay restitution to their victims in an amount to be determined at a later date.
A fourth defendant, Dela Saidazim of Moscow, Russia, was sentenced to time served in December 2022. Three additional co-defendants, David Bishoff and Brycen Millett both from Saint George, Utah and Joshua Alegria of Woodland Hills, California are awaiting sentencing. An eighth co-defendant and the leader of the criminal organization, Brian Sutton of Moscow, Russia, a U.S. citizen who is believed to be residing abroad, remains at large.
According to court filings and proceedings, between 2017 and 2022, the defendants engaged in an international scheme to fraudulently bill private health care benefit programs. They executed their scheme by having call centers they controlled, initially in Utah and later in Russia, contact beneficiaries enrolled with the Private Insurers and offer medications at no cost to the beneficiaries and without any medical exams to determine if the medications were necessary.
Regardless of whether the beneficiaries agreed to receive these medications, the defendants generated fraudulent prescriptions for the medications for these beneficiaries. The defendants also recruited doctors purportedly to review prescriptions by nurse practitioners and physician’s assistants after telemedicine visits. Contrary to what the recruited doctors were told, in most cases there were no telemedicine visits between the beneficiaries and any medical professionals. The defendants generated fraudulent prescriptions under the physicians’ names and National Provider Identifier numbers. Despite the prescriptions, many beneficiaries never received the medications.
The defendants also acquired pharmacies across the United States with pre-existing relationships with the Private Insurers and trained and managed teams of Moscow-based “billers” to input data and remotely submit electronic reimbursement requests for the fraudulent prescriptions through those pharmacies. The defendants submitted over $1.97 billion in fraudulent prescriptions according to third-party billing records. Private Insurers paid over $758 million as a result of those fraudulent submissions.
To conceal their involvement in the scheme, the defendants operated under multiple aliases, funneled hundreds of millions of dollars through pass-through shell companies and straw owners, used end-to-end encrypted communications and moved operations overseas. Specifically, the defendants purchased and operated dozens of existing brick-and-mortar pharmacies through straw owners, including in Brooklyn, Staten Island, Manhattan, Long Island, New Jersey, Pennsylvania, Texas, Michigan and Alabama. The defendants also laundered millions of dollars in fraudulent proceeds from overseas through pass-through shell companies that they used to purchase the scheme pharmacies and conceal the defendants’ involvement.
The government’s case is being handled by the Office’s Business and Securities Fraud Section. Assistant United States Attorneys John Vagelatos, Jessica K. Weigel, Jonathan P. Lax and Tara B. McGrath are in charge of the prosecution, with the assistance of Paralegal Specialist Melina Piatti-Chayan. Assistant United States Attorney Claire S. Kedeshian of the Office’s Asset Forfeiture Section is handling forfeiture matters.
On April 7, the Department of Justice announced the creation of the National Fraud Enforcement Division (Fraud Division). The Fraud Division is laser-focused on investigating and prosecuting those who commit fraud against the American people. The Department’s work to combat fraud supports President Trump’s Task Force to Eliminate Fraud, a whole-of-government effort chaired by Vice President J.D. Vance to eliminate fraud, waste, and abuse within Federal benefit programs.